Provider Demographics
NPI:1326357427
Name:CHIROPRACTIC CONCEPTS OF AVON LAKE INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CONCEPTS OF AVON LAKE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:POYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-933-7894
Mailing Address - Street 1:32730 WALKER RD
Mailing Address - Street 2:F3
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-4100
Mailing Address - Country:US
Mailing Address - Phone:440-933-7894
Mailing Address - Fax:440-933-5231
Practice Address - Street 1:32730 WALKER RD
Practice Address - Street 2:F3
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4100
Practice Address - Country:US
Practice Address - Phone:440-933-7894
Practice Address - Fax:440-933-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO0785611Medicare PIN